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What Gastroenterologists Want You to Know About Ulcerative Colitis

10 Expert Strategies for Better Ulcerative Colitis Management

Ulcerative colitis is a chronic inflammatory disease that, as of today, can’t be cured. But the condition can be managed with long periods of remission.

“New medications for ulcerative colitis work really well in the vast majority of patients — there’s a lot of reason to be optimistic,” says Ellen Zimmermann, MD, a gastroenterologist and professor of medicine at the University of Florida in Gainesville. What’s more, ulcerative colitis can be successfully managed when patients take better control of their condition and provide feedback to their care team, according to a 514-person study published in the journal Inflammatory Bowel Diseases in 2014.

To help you take back the reins on your health, we asked a few ulcerative colitis experts to share their most important strategies for ulcerative colitis management. Here’s what you should know.

Love Your Medical Team

Because ulcerative colitis is a lifelong condition, you want to put together a team of health care providers — doctors, nurses, and support staff — you'll feel comfortable working with over a long time. "If the patient and health care team aren’t on the same wavelength, condition management is hard,” Dr. Zimmermann says.

Experiencing Symptoms? Pick Up the Phone

When symptoms develop, don’t try to power through them on your own. Your doctor can help you cope with a flare-up or order tests to identify potential complications. “Call before you’re feeling really ill,” says Ann Flynn, MD, a gastroenterologist with University of Utah Health Care in Salt Lake City.

Ulcerative colitis can impact more than just your digestive tract — it can affect your joints, eyes, and skin, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). That means you should call your doctor about any changes you’re experiencing. In addition, ulcerative colitis increases the risk for infections like Clostridium difficile, according to research published in the World Journal of Gastroenterology in 2013, so it’s important to report changes early on.

Take Medication Exactly as Prescribed

What causes flare-ups? Too often, they can be traced to not taking medications as prescribed, according to a review of health records from 134 people with inflammatory bowel disease published in the World Gastroenterology Journal in 2014. “The way to deal with ulcerative colitis is to bring down the inflammation and keep it down," Zimmermann says. "So if you constantly let it flare up by not taking your medications or letting them run out, you let the disease perpetuate."

Study Up on Ulcerative Colitis

Educating yourself, doing the research, and talking about issues with your team will help you feel confident that you’re doing everything you can to manage ulcerative colitis, Zimmermann says. "The patients who challenge me the most are the patients I like taking care of the best. They bring in articles to ask me questions,” she says.

Leonard Baidoo, MD, a gastroenterologist and assistant professor of medicine at the University of Pittsburgh, agrees that education about ulcerative colitis is key. “Know the causation, treatments, and side effects of medication,” he says.

Eat With Ulcerative Colitis in Mind

A rule of thumb about diet and ulcerative colitis: Good nutrition is a must. A healthy diet can help you fight infection and prevent malnutrition and vitamin deficiencies. You may also want to figure out if any foods worsen symptoms for you. For example, symptoms may be reduced if you give up carbonated drinks, popcorn, and high-fiber foods, according to the NIDDK.

“When they feel their symptoms are active, most people with ulcerative colitis prefer to eat a bland sort of diet and frequent small meals, avoiding complicated, spicy, processed foods,” Zimmermann says, adding that, in remission, some people often continue to eat small frequent meals but with a wider variety of foods.

Know Your Nutrient Profile

Nutrient deficiencies can be a problem if you aren't able to take in enough food to get the essentials. Talk with your doctor about checking your B12 and vitamin D levels in particular, Dr. Baidoo advises. If blood tests reveal nutritional deficiencies, your doctor may recommend supplements.

Research on supplements for ulcerative colitis is slim, but omega-3 fatty acids might play a positive role, according to a review published in the World Journal of Clinical Cases in 2014. You can get omega-3s from supplements as well as from fatty fish, like salmon.

Protect Your Heart

Ulcerative colitis doesn’t have anything to do with heart health, right? Wrong. “Since ulcerative colitis is an inflammatory disease, it has an impact on the heart,” Zimmermann says. The risk for heart disease complications, such as clots and stroke, seems to go up during flares, according to a 2014 report in the World Journal of Gastrointestinal Pathophysiology.

People with IBD also appear to fare worse after a heart attack than peers who don't have IBD, according to a study published in Circulation: Cardiovascular Quality and Outcomes in 2014. Work with your team on a heart-healthy diet and exercise program.

Protect Your Bones Too

Certain factors put bone health at risk when you have an inflammatory bowel disease: vitamin D deficiency, lengthy corticosteroid use, being a man or of Asian descent, according to research published in Digestive Diseases and Sciences in 2014. Dr. Flynn recommends getting bone density screenings and asking your health care providers about strategies that might help protect your bones, such as taking calcium and vitamin D supplements and quitting smoking.

Keep Records and Compare Notes

“Take notes about therapies you have used, the doses, and how you responded,” Flynn advises. Also track your symptoms and any factors that you feel might be related, such as diet, stress, or exercise. Bring your notes and a list of questions with you to every appointment, and don’t hold back. “Your doctor’s visit is your time to bring up what’s on your mind, including financial concerns, plans for pregnancy, and the impact of ulcerative colitis on your life and work,” Flynn points out.

Stick With Your Colonoscopy Schedule

The American Cancer Society notes that ulcerative colitis puts you in the high-risk category for colorectal cancer starting several years after ulcerative colitis symptoms begin. The organization recommends having a colonoscopy every one or two years, based on your physician’s advice. It may be tempting to put off this screening, but don’t. “It’s important to stick with your doctor’s plan,” Zimmermann stresses.

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